Provider Demographics
NPI:1104923283
Name:EASON, LORI ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:EASON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16327 PRAIRIE GARDEN
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015
Mailing Address - Country:US
Mailing Address - Phone:806-379-9090
Mailing Address - Fax:806-379-9091
Practice Address - Street 1:3702 I-40 EAST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103
Practice Address - Country:US
Practice Address - Phone:806-379-9090
Practice Address - Fax:806-379-9091
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4984T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52604Medicare UPIN
TX00366HMedicare ID - Type Unspecified